JENNIFER ROSE DEFAZIO MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057811

License Status

EXPIRED

Business

Title

First Name

JENNIFER

Middle

ROSE

Last Name

DEFAZIO

Business Name

JENNIFER ROSE DEFAZIO MD

Original Issue Date

06/24/2010

Effective Date

06/24/2010

Expiration Date

06/23/2013

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

10/07/2013